Covid-19 (previously called novel coronavirus) is a new strain of a coronavirus that emerged in China in late 2019. Coronaviruses belong to the family sarcoviridae, a large family of viruses. Rarely, the new strain of the virus can jump from animals to humans to cause disease, other examples: SARS, MERS.
NEW VARIANT OF COVID:
Due to the spread of a new variant of Covid-19, there has been a rise in cases. Studies have proven that the Coronavirus has replicated into a new form, which leads to the spread of this new variant. India reported over 1.60 lakh new covid cases, today in the last 24 hrs, according to the union health ministry.
As Covid -19 cases keep increasing around the world owing to the new strains of the virus, many countries have gone back to reimposing their lockdowns to control the spread. France, Italy, Belgium, Poland, Hungary, etc. In India, New Delhi, Maharashtra, Karnataka have implemented strict lockdown.
Due to this rapid spread all over the country, doctors, health care professionals are at higher risk in treating patients and serving society. In addition, the high chances of infection are a threat to the dentist, on examining the oral cavity.
SIGNS AND SYMPTOMS:
Meanwhile, certain common symptoms include,
MODE OF TRANSMISSION:
Predominately the spread occurs by respiratory droplets (when someone coughing) and contact (hands→ surfaces → eyes and mouth.)
PATIENT SCREENING (MANDATORY FOR EVERY CLINIC):
- The dental staff members should communicate with the patients and the person accompanying them regarding recent infection, travel history.
- Before visiting the dental clinic, patients should call the clinic and confirm their appointments. They should come only in their allotted time, in order to avoid crowding in the clinic.
- Children should be accompanied by any of their family members for the treatment.
- It’s mandatory that every patient and member accompanying them should be provided with hand sanitizer in the reception office. Check temperature and oxygen level.
- Check the oxygen levels
- A brief history of the child’s recent respiratory infection, chronic infections, the recent history of fever should be asked. Re-schedule appointments in case of fever for the past 24 hours
- In the case of a covid infected child, it’s always better to schedule appointments at the end of the day. This prevents contamination with the other patients.
- Re-schedule appointments for patients who have a higher temperature.
- The doctors, dental assistants, nurses should wear PPE kits for treating patients.
- They should wear head caps, goggles, gloves, N -95 mouth mask, face shield, foot cover. In order to avoid the transmission of infection and to prevent any sort of infection spread from the doctor to the patient.
- The dental assistant should also wear gloves while assisting.
STEPS OF DONNING A PPE:
Donning is the wearing of PPE.
- Wash hands with hand wash or soap for 40-60 secs or hand sanitizer for 30 secs.
- Wear PPE gown
- Wear mask
- Put on the head cap, goggles.
- Wear face shield.
- Finally put on the gloves.
- Before performing any aerosols procedure or any surgery it’s always good to wear double gloves and a double mask.
- Since dentists are at high risk of infection wearing double masks, double gloves prevent the chances of infection.
- A double mask means wearing a surgical mask over the N 95 mask.
- Vaccination at the earliest is important.
- After treating patients the PPE should be disposed of in a proper way.
STEPS OF DOFFING A PPE:
The term ‘doffing’ refers to the proper method of removing PPE.
- Remove the glove, followed by the goggles, face shield, gown, and finally the mask.
- Wash hands with soap or hand wash for 40-60 secs.
Most importantly, have someone supervise while you’re donning or doffing a PPE. This prevents carelessness on the part of the wearer.
UNIVERSAL HAND WASHING TECHNIQUE:
WHO recommended certain protocols for hand washing .They divided it as two techniques :
- HAND HYGIENE TECHNIQUE WITH ALCOHOL BASED FORMULATION ( HAND SANITIZER)
- HAND HYGIENE TECHNIQUE WITH SOAP AND WATER.
TECHNIQUE WITH SOAP AND WATER:
The duration of this entire procedure is 40 -60 secs.
1- Wet hands with water. Apply soap in the palm.
2- Rub hands palm to palm.
3– Right palm over left palm interlaced and vice versa.
4– Palm to palm with fingers inter laced.
5– Rub the back side of finger towards palm .
6– Keep the left thumb clasped in right palm and continue to rub in circular direction vice versa.
7- Rub in front and back direction with inter digits locking of right hand in left palm and vice versa
8- Rinse hands with water.
9- Dry hands thoroughly ,with a single use of towel.
HAND HYGIENE TECHNIQUE WITH ALCOHOL-BASED FORMULATIONS:
The duration of this entire procedure: 20-30 secs.
Apply required amount of sanitizer in the hand surface.
Right palm over left dorsum fingers interlaced, vice versa.
Palm to palm with fingers interlaced.
In addition, rub the back side of fingers towards opposing palm.
Keep the left thumb clasped in right palm and continue to rub in circular direction vice versa.
Finally, rub in front and back direction with digits inter-locked (Right hand in left palm and vice versa).
DENTAL CLINIC SETUP FOR COVID:
- Firstly, ventilation plays a major role.
- Reduce contact by removing objects like toys, papers, magazines, etc.
- Similarly, no greetings in the form of a handshake, touch contact should be avoided.
- After treating every patient, the dental chair should be fumigated properly.
- After completing all the dental treatment, before closing the clinic infrared UV lights should be switched on for fumigating the area. This removes the germs completely in the work area.
- Regularly clean AC filters. It’s always good to avoid using AC during dental procedures, it might serve as a medium in transmitting the infection.
- The sterilization protocol is mandatory for every clinic. Sterilize instruments regularly in an autoclave. Use glass bead sterilizer for burs, tips, etc.
- In addition, pack the diagnostic instruments (mouth mirror, probe, explorers) in a cover and make a kit.
- Do the re-use the kits.
PROTOCOLS FOR COVID:
- In the pandemic situation, since dentists are at high risk of infection, only emergency procedures are performed across the country (according to American dental association protocol). Likewise, elective procedures should be performed only after the pandemic
- This was the protocol followed in 2020, the same protocol should be implemented now due to the increasing spread of the second wave of coronavirus.
- Children should be provided with a mouth rinse before the procedure this is termed a pre-procedural mouth rinse. Give mouth rinses like hydrogen peroxide. Moreover, this decreases the viral load.
- Besides, the pre-procedural mouth rinse kills the lipid layer of Coronavirus.
- Chlorhexidine mouthwashes (0.12%) are standard. But, it has low antiviral property.
- For children who are affected with a respiratory illness like asthma or any immunological compromised conditions like tuberculosis proper medical history should be taken and should be treated under utmost care (appointments should be scheduled first before all patients).
- For patients who are already affected with covid, it’s better to schedule appointments for the end of the day. To prevent the spread of infection to other patients. Provided them with a head cap, foot cover, and gowns before treatment. These patients have a higher risk of getting an infection when compared with other patients.
OTHER STEPS INCLUDE:
- The doctor, dental staff members everyone should wear an N-95 mask, goggles, face shield, PPE gown, etc.
- They should avoid touching the face, nose, and ears. This might spread the infection easily.
- Moreover, the dental chair, three-way water syringes, suction tips everything must be cleaned and fumigated after each patient. The suction tips should be discarded after a single-use. Three-way water syringes should be cleaned with saline.
- Performing treatment to children affected with cerebral palsy, visual impairment, physically disabled children is very challenging during this pandemic situation. It’s always better to start with preventive treatment for those children.
- The preventive procedures include atraumatic restoration(ART), pit and fissure sealants, applying silver diamine fluoride, applying varnish. Above all, these procedures avoid the use of high-speed handpieces which might produce aerosol infection to the children.
- The dental setup must be well ventilated and there must be ventilation with natural airflow of 160L in one room.
- The treatment is performed using rubber dams and high-volume suction tips. Moreover, use external suction.
- Finally, after performing all dental procedures, the PPE should be disposed of with the proper technique of donning and doffing.
- In addition, clean surfaces using disinfectants.
To sum up, due to the increasing spread of coronavirus in its second wave, following these protocols in our dental practice will minimize the risk of infection to the patients, doctors and dental staff members, and their families.